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Biomedical subjects

A H Friedlander

Publications and source records attributed to A H Friedlander.

At least 19 recordsLinked to original sources
PubMed1996

Panoramic dental radiography: an aid in detecting individuals prone to stroke.

Stroke (cerebrovascular accident, CVA) is the third leading cause of death and an important cause of hospital admission and long-term disability in England and Wales. Atherosclerotic lesions at the bifurcation of the common carotid artery are the most common cause of stroke. On occasion, these lesions are partially calcified and visible on a conventional panoramic dental radiograph. The atheroma may appear either as a nodular radiopaque mass or as two radiopaque vertical lines within the soft tissues of the neck at the level of the lower margin of the third cervical vertebra (C3). These opacities are separate and distinct from the hyoid bone and variably appear above or below it. Dentists should scrupulously review the panoramic radiographs of all individuals over the age 55 with medical histories (hypertension, diabetes mellitus, hypercholesterolaemia, coronary artery disease) and behaviours (smoking, alcohol abuse, dietary indiscretion, overweight, sedentary life-style) known to be associated with atherosclerosis and stroke.

Aged↗
PubMed1996

Lateral cephalometric radiographs: an aid in detecting patients at risk of stroke.

Stroke is often caused by atherosclerotic lesions in the bifurcation of the common carotid artery. The authors evaluated conventional lateral cephalometric radiographs of 1,063 healthy men aged 25 to 85 years for the presence of such lesions. Approximately 2 percent of these people had lesions, which were at the level fo the third and fourth cervical vertebrae and were superimposed over these structures, the pre-vertebral fascia and the pharyngeal air space. People with atherosclerotic lesions should be referred to their physicians because timely medical, surgical and lifestyle interventions can prevent strokes.

Adult↗
PubMed1995

Identification of stroke-prone patients by panoramic and cervical spine radiography.

OBJECTIVE: To determine if calcified atherosclerotic lesions in the region of the bifurcation of the common carotid artery (a major cause of stroke) can be identified by conventional panoramic dental radiography. METHODS: All those aged 65 years or older, of 500 consecutive out-patients enrolled in the dental clinic for comprehensive treatment and for whom it was possible to obtain a technically satisfactory panoramic radiograph, were included. The radiographs were evaluated for the presence of radiopacities within the soft tissues of the neck at the level of the lower margin of the third cervical vertebra. An antero-posterior cervical spine radiograph was obtained of those individuals with any such calcifications. Medical histories were obtained from patients with suspected lesions in order to determine the presence of risk factors known to be associated with stroke. RESULTS: Six individuals (4.5% of the final study population) had radiopacities which were confirmed by radiographs of the cervical spine to be calcified atheromas. The medical histories revealed risk factors associated with stroke. CONCLUSION: Panoramic radiographs obtained during the course of routine dental treatment may demonstrate calcified carotid atheromas in patients at risk of stroke.

Aged↗
PubMed1994

Prevalence of detectable carotid artery calcifications on panoramic radiographs of recent stroke victims.

Cerebrovascular accidents are responsible for killing or disabling half a million Americans every year and are the third leading cause of death in this country. Finding cost-effective means of decreasing stroke mortality and morbidity is of great humanitarian and economic importance. Panoramic dental radiography was done on 19 white men who had a recent cerebrovascular accident and who were hospitalized at a Department of Veteran Affairs medical center. Inclusion criteria included clinical suspicion or imaging study evidence that the stroke arose from atheroembolic disease of the carotid artery bifurcation. Women were omitted from the study because of their paucity in the patient pool, and African-Americans and Asian-Americans were omitted because strokes in those groups usually develop as a result of disease of intracranial vessels. Carotid arterial calcifications appearing as a radiopaque nodular mass adjacent to the cervical vertebrae at or below intervertebral space C3-4 were noted in seven persons (37%). These patients had an average age of 65 years and demonstrated multiple risk factors (prior transient ischemic attacks, prior stroke, hypertension, obesity, tobacco and alcohol abuse, hyperlipidemia) associated with occurrence of a stroke. We concluded that some white men at risk for a cerebrovascular accident may be identified in the dentist's office by appropriate review of the panoramic dental radiograph and medical history. The presence of carotid artery calcifications demands an expeditious referral to an appropriate practitioner who can assist in the control of risk factors and arrange prophylactic surgical removal of the carotid arterial plaque, which are both safe and reliable methods of reducing the incidence of stroke.

Aged↗
PubMed1994

Panoramic dental radiography as an aid in detecting patients at risk for stroke.

PURPOSE: Atherosclerotic lesions in the region of the bifurcation of the common carotid artery and in the internal carotid artery are the most common cause of stroke. On occasion these lesions are calcified and visible on a panoramic dental radiograph. METHODS: Six subjects receiving outpatient dental treatment and denying a history of previous transient ischemic attacks or stroke had bilateral calcified carotid arterial lesions noted on their routine panoramic dental radiograph. RESULTS: Electronic thermography (ET) demonstrated that these patients had significant temperature differences bilaterally between their medial supraorbital region and the ipsilateral remainder of their forehead when compared with control subjects. These findings are consistent with the presence of calcified stenotic intraluminal plaques altering blood flow, tissue perfusion, and skin temperature readings. The presence of stenotic plaques was verified by Doppler spectral analysis and imaging. CONCLUSION: ET of the face, currently considered an investigational procedure, demonstrates promise as an ancillary imaging system capable of confirming the diagnosis of patients at risk of stroke. Such individuals should be referred to an appropriate physician for consideration of medications and/or surgical removal of the plaque. In selected individuals, these are safe and relatively reliable methods of preventing stroke.

Aged↗
PubMed1994

Pathogenesis and prevention of native valve infective endocarditis in elderly dental patients.

Elderly dental patients are at risk of developing infective endocarditis. Increased longevity is associated with an increased prevalence of cardiac valvular disease and impairment of the immune system. Aortic stenosis commonly occurs in persons between 60 and 75 years of age. Degenerative calcification of the mitral valve ring leading to valve incompetency often develops in those over age 70 years. Men over the age of 60 years with mitral valve prolapse and systolic hypertension are at risk of infective endocarditis because the excessive haemodynamic load placed upon the abnormal valve causes extensive stretching of cusps and loss of valve surface endothelium. Dental procedures, that result in mucosal or gingival bleeding (most notably dental extractions, periodontal probing, scaling and surgery, endodontics and restorative procedures which extend below the gingival line), frequently produce a bacteraemia. Anaerobic strains of bacteria are isolated twice as frequently as aerobic strains. Antibiotic prophylaxis decreases the level of bacteraemia, prevents adherence of bacteria to the damaged valvular epithelium and suppresses the growth of those microbes that manage to adhere to the valve. The standard prophylactic regimen consists of amoxicillin 3g 1 hour before the dental procedure, then 1.5g 6 hours after the initial dose. Erythromycin is a good alternative for penicillin-allergic patients. Topical chlorhexidine 5 minutes before initiating dental therapy reduces the bacterial inoculum and the likelihood of endocarditis.

Aged↗
PubMed1992

Dental treatment of patients with Gilles de la Tourette's syndrome.

Gilles de la Tourette's syndrome, a familial neurologic disorder with onset in early life, is characterized by chronic intermittent motor and vocal tics. Many of the orofacial tics and compulsive behaviors seen in this disorder may cause destructive oral lesions. The medications used in treating the syndrome may adversely interact with dental therapeutic agents, frequently cause hyposalivation associated with the development of dental caries and periodontal disease, and may produce tardive dyskinesia with buccolingual choreiform movements. The oral signs and symptoms associated with the syndrome are reviewed, and modifications in dental treatment on the basis of the patient's behavioral alterations, and current drug therapy are suggested.

Bruxism↗
PubMed1992

Pseudocysts of the mandibular condyle.

The panoramic radiographs of 507 consecutive patients receiving comprehensive dental treatment were evaluated for the presence of radiolucencies in the mandibular condyles. Nine patients met the study criteria. Five patients had bilateral and four patients had unilateral circumscribed radiolucencies in the anterior aspect of the condyle. Computerized tomography confirmed that these radiolucencies were age-related anatomic variants that were accentuated and distorted during panoramic radiography.

Adult↗
PubMed1991

Dental management of the patient with major depression.

Major depression is a psychiatric disorder in which mood, thought content, and behavioral patterns are impaired for long periods of time. It is a common disorder, with an increasing prevalence among young adults. It may be associated with a disinterest in performing appropriate preventive oral hygiene techniques, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education program, the use of saliva substitutes and anticaries agents containing fluoride, and special precautions when prescribing or administering analgesics and local anesthetics.

Anesthesia, Dental↗
PubMed1990

Polymyalgia rheumatica and temporal arteritis.

Polymyalgia rheumatica and temporal arteritis are separate but overlapping rheumatic diseases commonly seen among elderly persons. Polymyalgia rheumatica is characterized by upper body and trunk myalgias/arthralgias and an elevation in erythrocyte sedimentation rate. In about half of patients, temporal arteritis begins after polymyalgia rheumatica. Temporal arteritis is a systemic granulomatous disease that predominantly affects branches of the carotid artery. Claudication of the muscles of mastication and a painful burning tongue may develop during temporal arteritis or be the initial presenting symptoms. Recognition that these orofacial manifestations may be part of the disease process is mandatory because one third of patients with untreated temporal arteritis may go blind.

Aged↗
PubMed1990

Pathogenesis, management, and prevention of infective endocarditis in the elderly dental patient.

Aortic stenosis and mitral valve insufficiency are common precipitating causes of infectious endocarditis in older persons. These degenerative cardiac valvular lesions may result from an exaggerated calcification process seen in association with aging. Mitral valve prolapse, especially when noted in an older man, may predispose the person to infectious endocarditis. Infectious endocarditis is harder to diagnosis and treat in older persons, and about half of patients die of the disease or its complications. Prophylactic antibiotics must be prescribed for patients with degenerative cardiac or atherosclerotic valvular defects having dental procedures likely to produce a bacteremia.

Aged↗
PubMed1989

Mental nerve neuropathy: a symptom of Waldenström's macroglobulinemia.

The uncontrolled production of immunoglobulins in Waldenström's macroglobulinemia, a neoplastic plasma cell disorder, results in hyperviscosity of blood and multisystem organ derangement. Previously reported orofacial manifestations have been limited to osteolytic lesions of the jaw, ulcerations of the mucosa and tongue, gingival bleeding, and enlargement of salivary and lacrimal glands. Mental nerve anesthesia resulting from IgM deposition on the myelin sheath is a previously unreported early warning sign of advancing disease. Its occurrence heralds the need for aggressive medical management.

Adult↗
PubMed1989

Temporal lobe epilepsy: its association with psychiatric impairment and appropriate dental management.

Temporal lobe seizures are manifested by aberrant experiences, automatic behavior, or both. In addition, approximately 40% of the patients who have had the disease for more than 15 years exhibit significant personality disorders, mood changes, or psychoses in the periods between seizures (interictal phase). Recognition that these characterologic manifestations are components of the underlying neurologic disorder allows for a more rational approach to the provision of dental care.

Dental Care for Persons with Disabilities↗